POS0158 ADHERENCE TO TELEMONITORING DISEASE ACTIVITY BY ELECTRONIC PATIENT REPORTED OUTCOMES IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A PROSPECTIVE COHORT STUDY
Authors: J. Wiegel, B. Seppen, M. Ter Wee, M. Nurmohamed, W. H. Bos
Journal: Annals of the Rheumatic Diseases (2022)

Background The use of electronic patient reported outcome measures (ePROM’s) enables telemonitoring disease activity in patients with inflammatory arthritis in between consultations. However, recent telemonitoring studies report declining long-term adherence to reporting ePROM’s 1,2 . What factors are associated with a decline in adherence is not known. Objectives To investigate the factors that are associated with adherence to telemonitoring by an ePROM in patients with inflammatory arthritis. Methods We performed a prospective cohort study in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) at Reade Amsterdam, The Netherlands. Patients telemonitored their disease activity weekly for 6 months with a modified Multidimensional Health Assessment Questionnaire including the Routine Assessment of Patient Index Data 3 (RAPID3) that was completed in the “MijnReuma” Reade smartphone application 2 . Adherence was defined as the percentage of weekly completed ePROM and time to dropout as ≥4 weeks nonresponse. Based on literature and through expert meetings, 13 baseline factors were selected to assess their association with dropout through multivariable Cox-regression analysis. The association with the system usability score (measured at 3 months, 1-100) was analyzed with a linear regression for patients who dropped out in month 1, month 2-3 and month 4-6. Results A total of 220 consecutive patients was included (mean age 54, 55% females, median disease duration 9 years), of which 99 had RA, 81 PsA, and 40 AS. Adherence to telemonitoring declined from 81% (week 1) to 39% (week 26). Median time to dropout was 17 weeks; a total of 141 patients (64%) stopped telemonitoring their disease activity. Women had a higher chance to dropout over time compared to men (HR 1.6, p=0.02). The reported usability of the app was higher for patients who were adherent throughout the study (82) compared to patients who dropped out in the 1 st month (68, p&lt;0.001), 2 nd -3 rd month (71, p&lt;0.001) and 4-6 th month (78, p=0.18). Conclusion Women stopped reporting the ePROM sooner than man and the usability score of the app differed between the adherence and drop-out group. Future research is needed to investigate if the association between the usability score of the app and adherence is causal, and thus if improvements in the usability will lead to lower dropouts. Furthermore, we will perform focus group discussions to identify why women tend to dropout sooner, since this is in contrary to previous research 3 . References [1]Lee YC et al. Outcomes of a Mobile App to Monitor Patient-Reported Outcomes in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2021 Aug doi: 10.1002/art.41686. [2]Seppen BF et al. Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies. JMIR Form Res. 2020 Sep. doi: 10.2196/20165. [3]Wiegel J et al. Adherence to Telemonitoring by Electronic Patient-Reported Outcome Measures in Patients with Chronic Diseases: A Systematic Review. Int J Environ Res Public Health. 2021 Sep doi: 10.3390/ijerph181910161. Table 1. Hazard ratios for dropout Variable HR 95%CI p Women 1,58 1,06; 2,36 0,02 Higher education 1,36 0,92; 2,02 0,13 Biological usage 1,18 0,83; 1,68 0,35 High medication adherence 1,14 0,80; 1,63 0,47 Diagnosis (relative to RA) PsA 1,14 0,77; 1,69 0,53 AS 1,09 0,63; 1,90 0,76 Smartphone usage 1,08 0,94; 1,23 0,29 Charlson Comorbidity index 1,05 0,78; 1,40 0,76 Resident in Amsterdam 1,02 0,72; 1,44 0,93 Disease duration 1,01 0,99; 1,02 0,49 Interaction patient-physician 1,00 0,92; 1,09 1,00 Self-management 1,00 0,98; 1,02 0,72 Age 0,99 0,96; 1,02 0,39 RAPID3 0,97 0,89; 1,06 0,51 Figure 1. Percentage weekly completed ePRO’s during the study. Disclosure of Interests Jim Wiegel: None declared, Bart Seppen: None declared, Marieke ter Wee: None declared, Michael Nurmohamed: None declared, W.H. Bos Grant/research support from: novartis and sanofi genzyme